This document provides an overview of hyaline membrane disease (HMD), also known as respiratory distress syndrome (RDS), for nursing students. It defines RDS as a lack of pulmonary surfactant, outlines its pathophysiology and risk factors. The document discusses the clinical presentation of RDS, including respiratory distress, radiographic findings and laboratory abnormalities. It also covers diagnosis, differential diagnoses, treatment including surfactant replacement and supportive care, complications and prevention of RDS through antenatal corticosteroids.

1. HARAMAYA UNIVERSITY
COLLEGE OF HEALTH AND MEDICAL SCIENCES
SCHOOL OF NURSING AND MIDWIFERY
SEMINAR ON: HYALINE MEMBRANE DISEASE (HMD)
(RESPIRATORY DISTRESS SYNDROME)
BY: Habtam and Hibaq Awil
MSc in Maternity & Neonatal Nursing Student
HARER, ETHIOPIA
February, 2021

2. Outline
 Introduction
 Pathophysiology
 Clinical manifestation
 Diagnosis
 Differential Diagnosis
 Complication
 Management
 Prevention
 Summary
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3. Objectives
At the end of this session students will be able to:
 Describe what hyaline membrane disease is
 Know the risk factors for its development
 Know the Role of Surfactant
 Understand the pathogenesis, common manifestations and important investigations
 List Differential Diagnosis of RDS
 Describe complication of RDS
 Manage a newborn with hyaline membrane disease 9/24/2023 3

4. Respiratory Distress Syndrome
(Hyaline Membrane Disease)
 Also known as hyaline membrane disease because of the deposition of a layer of hyaline
proteinacecous material in the peripheral airspaces of newborn.
 RDS is a low level or absence of surfactant system
 Results ineffective gas exchange required for the metabolic demands of the newborn.
 Impaired CO2 elimination and oxygen uptake
 At term the fetal alveoli are mature and ready to be inflated with air after delivery.
 These mature alveoli secrete a substance called SURFACTANT that prevents them collapsing
completely at the end of expiration.
 This allows the infant to breathe air in and out with very little physical effort.
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5. Cont.….
 HMD/RDS is the most common lung condition affecting premature babies.
 Premature babies can have both immature lung tissue and a lack of surfactant.
 The inadequate amount of surfactant causes alveoli to collapse when your baby breathes out.
 It is hard for your baby to re-inflate the collapsed alveoli when he breathes.
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6. Incidences
 The incidence and severity of RDS is generally inversely related to gestational age. Approximate incidence:
 24 weeks: >80 %
 28 weeks: 70%
 32 weeks: 25%
 36 weeks: 5%
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7. The risk of developing RDS increases
Maternal diabetes
Multiple births, caesarean section delivery,
Asphyxia
Infection
History of previously affected infants.
Male predominance.
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8. The risk of developing RDS decreases
 Chronic intra uterine stress
 Prolonged rupture of membrane
 Infection
 Corticosteroids use
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9. Physiology of surfactant
 Lipid material which prevent alveolar collapse
 Begin to be formed by type II alveolar cells around 20th week of gestation
 Phosphatidyl choline constitute 70% of lipid
 Phosphatidyl glycerol 10% of the total lipid and the marker of maturity…35th
week
 Surfactant proteins A,B,C and D are attached to the lipid substance
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10. Pathophysiology
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11. 9/24/2023 11

12. 9/24/2023 12

13. Cont..
Biochemical abnormalities
 The major hallmark of RDS is a deficiency of surfactant, which leads to higher surface
tension at the alveolar surface and interferes with the normal exchange of respiratory
gases.
 The higher surface tension requires greater distending pressure to inflate the alveoli,
according to the Laplace law.
 As the radius of the alveolus decreases (atelectasis) and as surface tension increases,
the amount of pressure required to overcome these forces increase
 The airways of the preterm infant are incompletely formed and lack sufficient cartilage
to remain patent. This can lead to collapse and increased airway resistance
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14. Cont.….
Morphologic/anatomic abnormalities
 The number of functional alveoli (and thus the surface area
available for gas exchange) decreases with decreasing
gestational age.
 The chest wall of the preterm newborn is more compliant
than the lungs, tending to collapse when the infant attempts
to increase negative intrathoracic pressure.
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15. Cont ….
Functional abnormalities
 Increased resistance
 Ventilation-perfusion abnormalities
 Impaired gas exchange
 Increased work of breathing
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16. Cont..
Histopathologic abnormalities
 RDS was originally referred to as hyaline membrane disease (HMD)
as a result of the typical postmortem .
Macroscopic findings
 Decreased aeration
 Firm, rubbery, “liver-like” lungs
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17. Cont…
Microscopic findings
 Airspaces filled with an eosinophilic-staining exudate composed of a
proteinaceous material, with and without inflammatory cells.
 Edema in the airspaces
 Alveolar collapse
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18. Pathogenesis
 Lack of surfactant  progressive collapse of alveoli  less compliant lung
(difficult to expand)  less ventilation  hypoxia (less O2), hypercapnia (high
CO2)  signs of respiratory distress
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19. Clinical Manifestations of RDS
 The clinical manifestations of RDS result primarily from abnormal pulmonary
function and hypoxemia.
 It presents within the first minutes or hours after birth.
 If untreated, RDS progressively worsens over the first 48 hours of life
 Flaring of the ala nasi: This increases the cross-sectional area of the nasal passages
and decreases upper airway resistance.
 Grunting: This is an attempt by the infant to produce positive end-expiratory pressure
(PEEP) by exhaling against a closed glottis.
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20. Cont…
 Retractions: The infant utilizes the accessory muscles of respiration, such as
the intercostals, to help overcome the increased pressure required to inflate
the lungs
 Cyanosis: This is a reflection of impaired oxygenation, in which there is more
than 5 g/dL of deoxygenated hemoglobin
 Tachypnea: The affected infant breathes rapidly, attempting to compensate
for small tidal volume by increasing respiratory frequency.
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21. Radiographic Findings
 The classic description is a “ground glass” or “reticulogranular” pattern with air
bronchograms
 Severe cases with near-total atelectasis may show complete opacification of the lung fields
(“white-out”).
 Most infants cases will have diminished lung volumes (unless positive pressure is being
applied).
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22. Laboratory Abnormalities
 Arterial oxygen tension is usually decreased.
 Arterial carbon dioxide tension initially may be normal if the infant is able to
compensate (tachypnea), but it is usually increased.
 Blood pH may reflect respiratory acidosis (from hypercarbia), metabolic acidosis
(from tissue hypoxia), or mixed acidosis.
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23. Diagnosis method
 Clinical evidence of respiratory distress
 Radiographic findings
 Laboratory abnormalities from impaired gas exchange
 Echocardiography. to rule out heart problems that might cause symptoms similar to RDS
 Complete blood count with differential
 Lab tests to rule out infections
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24. Differential Diagnoses
 Sepsis/pneumonia, especially group B streptococcal infection, which can
produce a nearly identical radiographic picture
 Transient tachypnea of the newborn
 Pulmonary hypoplasia
 MAS
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25. Treatment
 Early supportive care of premature infants, esp. treatment of acidosis, hypoxia,
hypotension ,& hypothermia, may lessen the severity of RDS.
 Establish adequate gas exchange including CPAP, Mechanical ventilation .
 Surfactant replacement
 Adjunctive measures
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26. Treatment
Establish adequate gas exchange
 If the infant is only mildly affected and has reasonable respiratory effort and
effective ventilation, only an increase in the FiO2 may be necessary. This can be
provided by an oxygen hood or nasal cannula
 If the infant is exhibiting evidence of alveolar hypoventilation (PaCO2 >50 mm
Hg [6.7 kPa]), or hypoxemia (PaO2 <50 mm Hg [6.7 kPa] in FiO2 = 0.5), some
form of positive pressure ventilation is indicated. Do the following
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27. 1 .Consider the use of continuous positive airway pressure (CPAP) if the infant has
reasonable spontaneous respiratory effort and has only minimal hypercarbia
2 ,Consider endotracheal intubation and mechanical ventilation the following
conditions exist:
 Hypercarbia (PaCO2 >60 mm Hg [8 kPa])
 Hypoxemia (PaO2<50 mm Hg [6.7 kPa])
 Decreased respiratory drive or apnea
 Need to maintain airway patency
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28. Cont..
3,Mechanical ventilation
The goal is to achieve adequate pulmonary gas exchange while decreasing the patient's
work of breathing.
Either conventional mechanical ventilation or high-frequency ventilation can be used.
RDS is a disorder of low lung volume; therefore the approach should be one that delivers
an appropriate VT while minimizing the risks of complications
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29. Surfactant replacement therapy
 The development and use of surfactant replacement therapy has revolutionized the
treatment of RDS.
 Types of intervention
a. Prophylaxis: Infant is immediately intubated and given surfactant as close to the first
breath as possible.
b .Rescue: Infant is not treated until the diagnosis is established.
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30. Adjunctive measures
 Maintain adequate blood pressure (and hence pulmonary blood flow) with judicious use of
blood volume expanders and pressors.
 Maintain adequate oxygen-carrying capacity in infants with a high oxygen (FiO2 >0.4)
requirement.
 Maintain adequate sedation/analgesia .
 Provide adequate nutrition but avoid excessive non-nitrogen calories, which can increase
CO2 production and exacerbate hypercarbia.
 Observe closely for signs of complications, especially infection.
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31. Complications
 Air leaks (Pulmonary interstitial emphysema Pneumothorax,Pneumo pericardium)
 Airway injury
 Pulmonary hemorrhage
 Chronic lung disease (broncho pulmonary dysplasia
 Patent ductus arteriosus, Congestive heart failure, Pulmonary hypertension
 Relationship to intraventricular hemorrhage
 Neurodevelopmental impact
 Nosocomial and acquired pneumonia
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32. Prevention
 Antenatal treatment of the mother with corticosteroids has been demonstrated to reduce the
incidence and severity of RDS, particularly if given between 28 and 34weeks of gestation
 Get consistent prenatal care throughout pregnancy
 Avoidance of unnecessary or poorly timed caesarean section,
 Appropriate management of high-risk pregnancy and labour
 Evaluation of L/S ratio for lung maturity L/S ratio = 2:1 in mature lung.
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33. Summary
 hyaline membrane disease is also known as Respiratory Distress Syndrome
(RDS)
 Respiratory distress syndrome (RDS) is a common problem in premature
babies. It can cause babies to need extra oxygen and help with breathing.
 Common Complication of Respiratory Distress Syndrome (RDS) are
Bronchopulmonary dysplasia (BPD) and Retinopathy of Prematurity(ROP).
 Treatment may include extra oxygen, surfactant replacement, and medicines.
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34. References
 Bajaj, L., et al. (2011). Berman's Pediatric Decision Making E-Book, Elsevier Health
Sciences.
 Farrell, P. M. and M. E. Avery (1975). "Hyaline membrane disease." American Review of
Respiratory Disease 111(5): 657-688.
 Spencer, H. (1985). "Pathology of the lung. Vol. 1." Pathology of the lung. Vol. 1.(Ed. 4).
 Aly H. Respiratory disorders in the newborn: Identification and diagnosis. Pediatrics in
Review 2004;25:201-207.
 Nelson textbook of pediatrics, 20th Edition
 Robbins and Cotran, Basic.Pathology.8th.Ed
 Neonatal Intensive Care Unit (NICU) Training Management Protocol, 2014.
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35. Acknowledgement
 We would like to say thank you to our instructor for giving this chances to read more
about to our topic provided
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36. Don’t be afraid to “think out of the box
Do no harm… this is someone’s baby
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